Before & After

Why Do We Show Case Studies and CT Scans?

For the simple reason that by publicly sharing the comparisons of CT scans before and after surgery the benefits of the procedure are documented for anyone who is considering these procedures. Also, by doing so, we choose to have our results examined by others.

Case #1: In Office Balloon Sinuplasty in Pansinusitis

Mrs A presented to us with 3-4 months of severe sinus problems and cough with stuffy nose and sinus pressure despite a prolonged course of antibiotics. She had In Office Balloon Sinuplasty of all six sinuses performed with ethmoid surgery under local anesthesia and some oral sedation. In the previous years this procedure would have been performed in the hospital under general anesthesia.

BEFORE & AFTER – All Sinuses Showing Diffuse Inflammation (in gray)

Frontal & Maxillary
Before Balloon Sinuplasty
Ethmoid & Sphenoid
Before Sinus Surgery
Right Frontal
Texas Sinus Surgery
Left Frontal
Sinus Surgery in Texas

AFTER SURGERY – Two Months Later Sinuses Are Clear (in black)

Balloon Sinuplasty Results
Texas Balloon Sinuplasty
Sinus Surgery
Sinus Surgery

Case Study #2: In Office Balloon Sinuplasty with Ethmoidectomy for Severe Sinusitis

Mrs G presented to us with many year history of moderate to severe stuffy nose, sinuses feeling blocked, sinus headache and decreased smell, fatigue and body pain despite many antibiotics and nasal sprays. In Office Balloon Sinuplasty of the frontal, maxillary and sphenoid sinuses performed with ethmoidectomy. She is very pleased with the results. CT scans show remarkable improvement 3 weeks after surgery.

BEFORE SURGERY

Ethmoid & Maxillary
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Both Frontal Sinuses
c2b-both-frontal-sinuses
Left Frontal Sinus
c2b-left-frontal-sinus

AFTER SURGERY – Three Weeks Later

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c2a-both-frontal-sinuses
c2a-left-frontal-sinus

Case Study #3: Child with Sinusitis, Standard Functional Endoscopic Sinus Surgery

Ms F, an 11 yr old child with severe sinusitis symptoms and headache, failed to respond to antibiotics. CT scan before surgery shows severe bilateral sphenoid sinusitis. CT scan after endoscopic sinus surgery shows beautifully open ethmoid and sphenoid sinuses with complete resolution of symptoms.

BEFORE SURGERY
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AFTER SURGERY
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Case Study #4: Severe Allergic Fungal Sinusitis and Extensive Sinus Surgery

Mr S presented to us with severe nasal congestion, sinus pressure, headaches, dirty green nasal discharge and poor smell despite two previous surgeries by another specialist. Nasal examination showed polyps and a CT scan of the sinuses revealed extensive sinusitis with polyps and destruction of bony walls between the sinuses and the brain, eye and the carotid artery. He was at risk for meningitis, brain abscess or eye complications. He underwent surgery over two days, the first extensive endoscopic sinus surgery and the second with external incision also called Modified External Lothrop Procedure (or MELP). He has done amazingly well since then.

BEFORE SURGERY

Frontal & Ethmoid Sinuses
c4b-frontal-ethmoid-sinuses
Sphenoid & Ethmoid Sinuses
c4b-sphenoid-ethmoid-sinuses

SOE is supraorbital erosion of bone, FBE is frontal bone erosion.

AFTER SURGERY – 6 Months Later

c4a-frontal-ethmoid-sinuses
c4a-sphenoid-ethmoid-sinuses

Case Study #5: Patients with Fungal Sinus Balls

Both these adult patients had balls of fungus in the sinuses. They both underwent standard endoscopic sinus surgery through the nose. CT scans show complete clearance of the sinuses after surgery.

Before Surgery – Sphenoid Sinus
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After Surgery – Sphenoid Sinus
c5a-sphenoid-sinus

Before Surgery – Maxillary Sinus
c5b-maxillary-sinus

After Surgery – Maxillary Sinus
c5a-maxillary-sinus


Case Study #6: Esthesioneuroblastoma of the Right Nasal Passage

Mr C presented to us with nasal congestion of the right side for years. CT showed a polyp in the right nasal passage arising from the smell receptor area also called the cribriform plate. He underwent endoscopic sinus surgery with complete clearance of tumor and preservation of the cribriform plate followed by radiation treatment. He is now 6 years out and has done very well without evidence of recurrence.

BEFORE SURGERY

The gray thin long mass on the left side as you face the images is the tumor.

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c6b-2

AFTER SURGERY and RADIATION – No Tumor Seen

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c6a-2

Case Study #7

After Balloon Sinuplasty in the office, an endoscope was passed into the sinus 3 weeks after surgery. The frontal or forehead sinuses are nicely lit up showing that the sinus openings are beautifully open after surgery. Normally it would be impossible to pass the endoscope into the frontal sinus.

Right Frontal Sinus
c7-right-frontal-sinus
Left Frontal Sinus
c7-left-frontal-sinus

Case Study #8

An individual with a rare condition of bilateral silent sinus syndrome, also called congenital maxillary hypoplasia. In this condition, the cheek or maxillary sinus is shrunken compared to a normal sinus resulting in some lowering of the eyeball or retrusion of the eyeball making the eyes look smaller. Here the CT scan shows before and after surgery results.

BEFORE SURGERY
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AFTER SURGERY
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Case Study #9

Mr K had diffuse chronic sinusitis with nasal polyps for a very long time causing nasal congestion, reduced smell and headaches with post nasal drip. He also had allergies as well. In addition there was a suspicion that one of the bones called fovea ethmoidalis or the roof of the ethmoid sinus (a thin piece of bone separating the sinus from the brain lining) was destroyed by the polyp on the right side. Despite this suspicion, we elected to do an in-office balloon sinuplasty with surgery on his ethmoid sinus (total ethmoidectomy) using a microdebrider. Dr. Khetarpal is one of few surgeons in this country performing six sinus balloon sinuplasty and total or near total ethmoidectomy in the office. We show in this CT scan that not only can this type of surgery be performed safely in the office but can yield excellent results. The CT scan results of before and eight months after surgery are shown.

BEFORE SURGERY
Ethmoid and Sphenoid Sinus
c9b-ethmoid-sphenoid-sinus

AFTER SURGERY
Ethmoid and Sphenoid Sinus
c9a-ethmoid-sphenoid-sinus

BEFORE SURGERY
Ethmoid Sinus
c9b-ethmoid-sinus

AFTER SURGERY
Ethmoid Sinus
c9a-ethmoid-sinus

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